• Document No. 001

  • Warning Title

  • Workers Name

  • Conducted on

  • Prepared by TJ LeMon

  • Location
  • Personnel on site

  • Workers Name

  • Date:

  • Description(s) of issues raised:

  • Description of controls to be put in place to prevent a re-occurrence

The Work Health & Safety Act 2012 (WHS Act 2012) Part 2, Division 4, Section 28 states; While at work, a worker must - a. take reasonable care for his or her own health and safety; and b. take reasonable care that his or her acts or omissions do not adversely affect the health and safety of other persons; and c. comply, so far as reasonably able, with any reasonable instruction that is given by the person conducting the business or undertaking to allow the person to comply with this Act; and d. co-operate with any reasonable policy or procedure of the person conducting the business or undertaking relating to health and safety at the workplace that has been notified to workers.

I understand that Nitro Drilling; * may contact my guardian (if under the age of 18 years) who is a party to my employment contract to discuss this warning and my progress with my employment; and * that my progress on this matter will be monitored by Nitro Drilling and failure to rectify this problem may result in further disciplinary actions being enforced that may result in termination of my employment with Nitro Drilling.

By my signature below I acknowledge that I understand and accept the above course of action to rectify the above mentioned issues:

  • Nitro Drilling Management - TJ LeMon (WH&S Advisor)

  • Worker

  • Witness (name & contact)

  • Has this warning been appropriately addressed?

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